Susan Collins is a clinical psychologist and assistant research professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington. Her research focuses on developing and enhancing interventions targeting substance-use disorders and integrating qualitative and quantitative methods to more comprehensively investigate the individual-level causes of substance abuse. She holds a Ph.D. from Syracuse University.

Chronically homeless individuals are disproportionately affected by severe psychiatric, medical and substance-use disorders. Ironically, housing for chronically homeless people usually comes with many strings attached, including sobriety, psychiatric stability and successful treatment completion. If individuals fail to meet housing requirements, they are essentially relegated to a life on the streets.

Project-based Housing First is a type of housing approach that turns this traditional model of housing on its head. Homeless individuals are provided with immediate, permanent, low-barrier, supportive housing within a single housing project. Project-based Housing First is considered to be ‘low-barrier’ because it removes the traditional barriers to housing, such as requiring sobriety, psychiatric stability and treatment attendance.

This approach has been controversial in some circles because critics have claimed that allowing alcohol dependent individuals to drink in their homes will ‘enable’ them to drink more and more and their drinking will spiral out of control.

To scientifically test the critics’ concerns, my colleagues and I evaluated alcohol use among 95 residents of a Housing First project. Contrary to the critics’ ‘enabling hypothesis,’ we found across-the-board decreases on alcohol consumption and related problems:

The average number of drinks consumed on the heaviest drinking day of the month decreased from 40 to 26 across two years, which was a decrease of 35 percent.

The median number of drinks, a more accurate view of drinking patterns for this study’s participants, showed a change from 20 to 12 drinks per typical drinking day – a 40 percent drop.

The percentage of residents reporting recent bouts of delirium tremens, a life-threatening form of alcohol withdrawal, dropped by more than half over the two-year study, from 65 percent to 23 percent.

Although these data are preliminary, they suggest that project-based Housing First may help reduce harm among chronically homeless people who would otherwise be relegated to a life on the streets.